2 OB Chapter 17 - Postpartum Physiologic Adaptations

During the second postpartum day, a woman asks the nurse, "Why are my afterpains so much worse this time than after the birth of my other child?" The best answer by the nurse would be: "Most women forget how strong the afterpains can be." "They should not be strong with you because you are breastfeeding." "You should not be feeling the pains now; I will notify the physician for you." "Afterpains are more severe for women that have already had babies."

"Afterpains are more severe for women that have already had babies."

When reading the postpartum chart the nurse notices that the client's fundus is recorded as "u+1". The nurse understands that this means the fundus is: 1 cm above the umbilicus. 1 cm below the umbilicus. 1 inch above the umbilicus. 1 inch below the umbilicus.

1 cm above the umbilicus.

What causes afterpains?

Afterpains are more acute for multiparas because repeated stretching of muscle fibers leads to low muscle tone that results in repeated contraction and relaxation of the uterus. Breastfeeding increases the severity of afterpains. The afterpains are self-limiting and will decrease rapidly after 48 hours.

While doing client teaching the woman tells the nurse, "I don't have to worry about contraception because I am breastfeeding." The nurse should base her answer on the fact that: Breastfeeding can be considered a reliable system of birth control. breastfeeding can be used as a contraceptive method if strict guidelines are followed through. Breastfeeding is not a reliable contraceptive method.

Breastfeeding is not a reliable contraceptive method.

Explain breast changes and when lactation occurs?

Breasts are essentially unchanged for the first 2 or 3 days after birth. Colostrum is present and may leak from the nipples. On day 3 or 4 lactation begins and engorgement can occur, resulting in the findings of b and c. Response d indicates problems with the breastfeeding techniques used.

How is the fundus measured?

Descent of the fundus is documented in relation to the umbilicus and is measured in centimeters. Numbers with the "+" sign means the fundus is above the umbilicus, numbers with the "-" sign means the fundus is below the umbilicus.

Explain why a new mother experiences diaphoresis during postpartum?

Diaphoresis and diuresis rid the body of excess fluids that accumulated during the pregnancy. Diaphoresis is not clinically significant, but can be unsettling for the mother who is not prepared for it. Explanations of the cause and provision of comfort measures, such as showers and dry clothing, are generally sufficient.

Constipation is a common problem during the postpartum period. Select all of the reasons for constipation during this period. Diminished bowel tone Overhydration during labor Episiotomy that causes the fear of pain with elimination Iron supplementation Some pain medications

Diminished bowel tone Episiotomy that causes the fear of pain with elimination Iron supplementation Some pain medications

What does excess lochia indicate?

Excessive lochia in the presence of a contracted uterus suggests lacerations of the birth canal. The health care provider must be notified so that lacerations can be located and repaired. The uterus is well contracted, so further massage is not necessary.

During the postpartum period the legs should be examined for signs and symptoms of thrombophlebitis. Select all of the signs and symptoms that are important to assess. Ashen color Heat Edema Decrease in pedal pulses Homans sign

Heat Edema Decrease in pedal pulses Homans sign

How large is the fundus? What direction does the fundus move?

Immediately after delivery the uterus is about the size of a large grapefruit and the fundus can be palpated midway between the symphysis pubis and umbilicus. Within 12 hours the fundus rises to the level of the umbilicus. By the second day the fundus starts to descend approximately 1 cm per day.

Describe Lochia?

Lochia rubra is red in color and occurs the first 3 or 4 days after birth. A light amount of discharge is classified as a 1- to 4-inch stain on the peripad.

Explain the process of a new mothers WBC?

Marked leukocytosis occurs during the postpartum period. The WBC count increases to as high as 30,000/mm3. The WBC count should fall to normal values by day 7. Neutrophils, which increase in response to inflammation, pain, and stress to protect against invading organisms, account for the major increase in WBCs. Because this is a normal reading, noting the results in the chart is the appropriate action.

When does a new mother start her menses again?

Menses in a breastfeeding mother may resume between 12 weeks and 18 months. Normally the first few cycles of menses are without ovulation; however, ovulation may occur before the first menses. Therefore, other contraceptive measures are important considerations for this mother.

The postpartum woman has a blood pressure of 150/90, pulse of 72 beats per minute, and respirations of 14 breaths per minute. She continues to bleed heavily. The order states she may have either methylergonovine (Methergine) 0.2 mg IM or oxytocin (Pitocin) 10 units IM for heavy bleeding. The nurse should administer which medication? Methylergonovine Oxytocin

Oxytocin

When assessing the perineum, episiotomy site, or surgical site, the nurse should assess for specific signs. Select all of the signs that are appropriate when assessing a surgical site. Redness Edema Ecchymosis Discharge Asymmetry

Redness Edema Ecchymosis Discharge

When should a mother be given Rhogram?

The mother is a candidate for Rh(D) immune globulin; however, it should be given with 72 hours after childbirth to prevent the development of maternal antibodies. Because she gave birth 4 days ago, that time period as passed and she is not sensitized to the positive blood.

Describe a postpartum C section mother

The post-cesarean section woman is usually on bed rest for the first 8 to 12 hours. She is at risk for pooling of secretions in the airway. By assisting her to turn, cough, and expand the lungs by breathing deeply at least every 2 hours, the pooling of secretions will be decreased.

The new mother is complaining of pain at the episiotomy site; however, because she is breastfeeding she does not want any medication. What other alternatives can the nurse offer this mother to help relieve the pain? Ambulation Topical anesthetics Hot fluids to drink Stool softeners

Topical anesthetics

A mother that is 3 days postpartum calls the clinic and complains of "night sweats." She is afraid that she is going into early menopause. The nurse should base her answer on the fact that: birth may put some women into early menopause; an appointment is needed to have this checked out. night sweats may be an indication of many other problems; an appointment is needed to assess the problem. diaphoresis is normal during the postpartum period, and comfort measures can be suggested to the mother. diaphoresis is normal only if the mother is breastfeeding.

diaphoresis is normal during the postpartum period, and comfort measures can be suggested to the mother.

Ice causes vasoconstriction and is most effective if applied soon after the birth to the perineal area to prevent ______________.

edema

One nursing measure that can help prevent postpartum hemorrhage and urinary tract infections is: forcing fluids. perineal care. encouraging voiding every 2 to 3 hours. encouraging the use of stool softeners.

encouraging voiding every 2 to 3 hours.

The placental site heals by a process of _______________.

exfoliation

The nurse is assessing the client's vaginal discharge. It is red and has about a 2-inch stain on the peripad. The nurse will record this finding as: light amount of lochia rubra. scant amount of lochia alba. moderate amount of lochia rubra. heavy amount of lochia alba.

light amount of lochia rubra.

Immediately after delivery the nurse can anticipate the fundus to be located: at the umbilicus. 2 cm above the umbilicus. 1 cm below the umbilicus. midway between the symphysis pubis and umbilicus.

midway between the symphysis pubis and umbilicus.

On the first day postpartum a client's white blood cell count is 25,000/mm3. The nurse's next action should be to: notify the physician for an antibiotic order. assess the client's temperature and blood pressure. request the count be repeated. note the results in the chart.

note the results in the chart.

When assessing a woman that gave birth 2 hours ago, the nurse notices a constant trickle of lochia. The uterus is well contracted. The next nursing action should be to: massage the fundus. continue to monitor. notify the physician. assess the blood pressure and pulse for changes.

notify the physician.

During the early post-cesarean section phase it is important for the woman to turn, cough, and deep breathe. The rationale for this is to prevent: pooling of secretions in the airway. thrombus formation in the lower legs. gas formation in the intestinal tract. urinary retention.

pooling of secretions in the airway.

A woman was admitted to the ED with her newborn baby. The baby was born 4 days ago at home. The woman had no prenatal care. The nurse is assessing the lab work and sees that the mother has O-negative blood type and the baby is O positive and the Coombs test shows the mother is not sensitized to the positive blood. The nurse's next action should be: order Rh(D) immune globulin to be given to the mother. order Rh(D) immune globulin to be given to the baby. record the findings of the lab work and not plan on any further action at this time.

record the findings of the lab work and not plan on any further action at this time.

The first time a woman ambulates after the birth of the newborn, she has a nursing diagnosis of Risk for Injury. The is due to the: risk for developing orthostatic hypotension. development of bradycardia. increase in cardiac output. increase in circulatory volume.

risk for developing orthostatic hypotension.

As part of the postpartum assessment, the nurse examines the breasts of a primiparous breastfeeding woman who is 1 day postpartum. An expected finding would be: soft, nontender; colostrum is present. leakage of milk at let-down. swollen, warm, and tender upon palpation. a few blisters and a bruise on each areola.

soft, nontender; colostrum is present.